使用多维尔评分指导弥漫性大B细胞淋巴瘤的巩固性放疗。

Using Deauville Scoring to Guide Consolidative Radiotherapy in Diffuse Large B-Cell Lymphoma.

作者信息

Yau Chun En, Low Chen Ee, Ong Whee Sze, Khoo Lay Poh, Hoe Joshua Tian Ming, Tan Ya Hwee, Chang Esther Wei Yin, Yang Valerie Shiwen, Poon Eileen Yi Ling, Chan Jason Yongsheng, Sin Iris Huili, Yeoh Kheng Wei, Somasundaram Nagavalli, Harunal Rashid Mohamed Farid Bin, Tao Miriam, Lim Soon Thye, Chiang Jianbang

机构信息

Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore.

Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.

出版信息

Cancers (Basel). 2024 Sep 27;16(19):3311. doi: 10.3390/cancers16193311.

DOI:10.3390/cancers16193311

PMID:39409931

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11475697/

Abstract

BACKGROUND

The most common aggressive lymphoma in adults is diffuse large B-cell lymphoma (DLBCL). Consolidative radiotherapy (RT) is often administered to DLBCL patients but guidelines remain unclear, which could lead to unnecessary RT. We aimed to evaluate the value of end-of-treatment PET-CT scans, interpreted using the Deauville score (DV), to guide the utilization of consolidative RT, which may help spare low-risk DLBCL patients from unnecessary RT.

METHODS

We included all DLBCL patients diagnosed between 2010 and 2022 at the National Cancer Centre Singapore with DV measured at the end of the first-line chemoimmunotherapy. The outcome measure was time-to-progression (TTP). The predictive value of DV for RT was assessed based on the interaction effect between the receipt of RT and DV in Cox regression models.

RESULTS

The data of 349 patients were analyzed. The median follow-up time was 38.1 months (interquartile range 34.0-42.3 months). RT was associated with a significant improvement in TTP amongst the DV4-5 patients (HR 0.33; 95%CI 0.13-0.88; = 0.027) but not the DV1-3 patients (HR 0.85; 95%CI 0.40-1.81; = 0.671) (interaction's = 0.133). Multivariable analysis reported that RT was again significantly associated with improved TTP among the DV4-5 patients (adjusted HR 0.29; 95%CI 0.10-0.80; = 0.017) but not the DV1-3 group (HR 0.86; 95%CI 0.40-1.86; = 0.707) (interaction's = 0.087).

CONCLUSION

Our results suggests that DLBCL patients with end-of-treatment PET-CT DV1-3 may not need consolidative RT. Longer follow-up and prospective randomized trials are still necessary to investigate long-term outcomes.

摘要

背景

成人中最常见的侵袭性淋巴瘤是弥漫性大B细胞淋巴瘤（DLBCL）。巩固性放疗（RT）常用于DLBCL患者，但指南仍不明确，这可能导致不必要的放疗。我们旨在评估治疗结束时使用迪沃利评分（DV）解读的PET-CT扫描对指导巩固性放疗应用的价值，这可能有助于使低风险DLBCL患者避免不必要的放疗。

方法

我们纳入了2010年至2022年期间在新加坡国立癌症中心诊断的所有DLBCL患者，这些患者在一线化疗免疫治疗结束时测量了DV。结局指标是无进展生存期（TTP）。在Cox回归模型中，基于接受放疗和DV之间的交互作用评估DV对放疗的预测价值。

结果

分析了349例患者的数据。中位随访时间为38.1个月（四分位间距34.0 - 42.3个月）。在DV4 - 5患者中，放疗与TTP的显著改善相关（风险比0.33；95%置信区间0.13 - 0.88；P = 0.027），但在DV1 - 3患者中并非如此（风险比0.85；95%置信区间0.40 - 1.81；P = 0.671）（交互作用的P = 0.133）。多变量分析报告称，在DV4 - 5患者中，放疗再次与TTP的改善显著相关（调整后风险比0.29；95%置信区间0.10 - 0.80；P = 0.017），但在DV1 - 3组中并非如此（风险比0.86；95%置信区间0.40 - 1.86；P = 0.707）（交互作用的P = 0.087）。